Prognostic Value of Stress Hyperglycemia in Patients Admitted to Medical/Geriatric Departments for Acute Medical Illness.
Prognostic Value of Stress Hyperglycemia in Patients Admitted to Medical/Geriatric Departments for Acute Medical Illness.
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DOI：
10.1007/s13300-021-01183-y
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Bianchi G
中科院分区：
文献类型：
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作者：
Di Luzio R;Dusi R;Barbanti FA;Calogero P;Marchesini G;Bianchi G
高血糖在入住意大利内科/老年病科病房的患者中很常见，且与较差的预后相关。我们检验了糖尿病和应激性高血糖在临床预后中的重要性。
纳入了378例入院时血糖升高（≥126mg/dl）的连续患者（206例无已知糖尿病），他们患有多种需要住院的基础疾病，且与是否患有糖尿病无关。相对高血糖计算为入院血糖除以平均血糖，平均血糖根据糖化血红蛋白估算。≥1.20的值被认为是应激性高血糖（SHR）的指征。通过逻辑回归分析检验了SHR与预后变量（全因并发症、感染、非感染性事件、死亡）的相关性，并对性别、体重指数、年龄校正的合并症（查尔森指数）和已知糖尿病进行了调整。
住院期间，96例患者（25.4%）发生了一种或多种事件；44例患者在医院死亡，无糖尿病患者的死亡率略高（14.6%对糖尿病患者的8.1%；P = 0.052），应激性高血糖患者的死亡率（15.0%）比SHR＜1.2的患者高近三倍（P = 0.005）。应激性高血糖——在无糖尿病患者中更常见（71%对58%）——和年龄是死亡的唯一独立预后因素。在多变量分析中，无糖尿病患者中死亡（比值比4.31，95%置信区间1.25 - 14.81）、所有并发症（比值比5.90，95%置信区间2.22 - 15.71）和新发全身性感染（比值比5.67，95%置信区间1.61 - 19.92）的风险与应激性高血糖相关，非胰岛素治疗病例的风险也是如此（比值比4.02，95%置信区间1.16 - 13.92；比值比5.47，95%置信区间2.21 - 13.52；比值比5.15，95%置信区间1.70 - 15.62）。
该研究证实了在因各种急性医疗状况需入住老年病科/内科病房的患者中，应激相关高血糖的预后价值，它导致的不良后果不限于通常与高血糖相关的事件（如感染）。
网络版包含补充材料，可在10.1007/s13300 - 021 - 01183 - y获取。
Hyperglycemia is common in patients admitted to Italian medical/geriatric units and is associated with a poorer outcome. We tested the significance of diabetes and stress-induced hyperglycemia in clinical outcome. Three hundred seventy-eight consecutive patients with hyperglycemia at entry (≥ 126 mg/dl) (206 without known diabetes) were included, with a wide range of underlying diseases requiring hospital admission and independent of the presence of diabetes. Relative hyperglycemia was calculated as admission glucose divided by average glucose, estimated based of glycosylated hemoglobin. Values ≥ 1.20 were considered indicative of stress hyperglycemia (SHR). The association of SHR with outcome variables (all-cause complications, infections, non-infectious events, deaths) was tested by logistic regression analysis, adjusted for sex, BMI, age-adjusted comorbidities (Charlson index) and known diabetes. During hospital stay, one or more events were registered in 96 patients (25.4%); 44 patients died in hospital, and fatality rate was borderline higher in patients without diabetes (14.6% vs. 8.1% in diabetes; P = 0.052) and nearly three times higher in patients with stress hyperglycemia (15.0%) vs. those with SHR < 1.2 (P = 0.005). Stress hyperglycemia—more common in the absence of diabetes (71% vs. 58%)—and age were the only independent prognostic factors for death. At multivariable analysis, the risks of death (OR 4.31, 95% CI 1.25–14.81), of all complications (OR 5.90, 95% CI 2.22–15.71) and of newly developed systemic infections (OR 5.67, 95% CI 1.61–19.92) were associated with stress hyperglycemia in subjects without diabetes, as was the risk in non-insulin-treated cases (OR 4.02, 95% CI 1.16–13.92; OR 5.47, 95% CI 2.21–13.52; OR 5.15, 95% CI 1.70–15.62, respectively). The study confirms the prognostic value of stress-related hyperglycemia in patients requiring hospital admission to a geriatric/medical unit for a variety of acute medical conditions, contributing to adverse outcomes not limited to events commonly associated with hyperglycemia (e.g., infections). The online version contains supplementary material available at 10.1007/s13300-021-01183-y.
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